In recent years, there has been an increase in the recognition of moulds other than Aspergillus as opportunistic pathogens in patients with haematological malignancies. We report here on 12 patients (8 male and 4 female; age range: 15-72 years) who developed 13 mould infections due to filamentous fungi other than Aspergillus spp. in a single Haematology Unit during the period 1986~ 1997 (7% of all invasive fungal infections). The most frequent risk factors were central venous catheter (11), previous broad-spectrum antibiotic (8), and neutropenia (8). Underlying diseases were AML (7), lymphoma (3), and ALL (2). Five patients had received haematopoietic progenitor cell transplantation (allogeneic 3, autologous 2). The fungal pathogens isolated were Mucor spp. (5), Scedosporium inflatum (3), Fusarium spp. (2), Acremonium spp (2), and Rhizopus rhizopodiformis (1). Two cases of Mucor spp. and one Fusarium spp. were associated to Aspergillus spp. Sites of infection were lung in 7 (4 Mucor spp, 1 Fusarium spp, 1 S. inflatum, 1 Acremonium spp), skin and soft tissue in 3 (2 S. inflatum, 1 Fusarium spp), catheter tunnel in 1 (Acremonium spp), oral cavity in 1 (Mucor spp) and paranasal sinuses in 1 (R. rhizopodiformis). One patient with lung infection caused by Mucor spp plus Aspergillus spp developed subsequently a disseminated infection due to S. inflatum. Seven of 12 patients (58%) were cured with amphotericin B. Surgical resection was performed in 4 cases. Of note, a case of sinusal mucormycosis only was definitely cured when hyperbaric oxygen was associated to antifungal therapy. Five patients (42%) died of fungal infection (two of them with active underlying disease).Fungal infections caused by moulds other than Aspergillus spp are relatively uncommon in patients with haematological malignancies and have a mortality rate similar to other invasive mycoses When feasible, surgery was of benefit and could have contributed to the better outcome of non-pulmonary infections.
Full conference title:
5th Trends in Invasive and Fungal Infections
- TIFI 5th